UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3892
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Braz Dent Sci 2023 Oct/Dec; 26 (4): e3892
Unlocking the secrets of saliva: the promising potential of salivary
biomarkers for evaluating crack use
Desvendando os segredos da saliva: o potencial promissor dos biomarcadores salivares para avaliar o uso de crack
Sandra Silva MARQUES
1
, Taís Maria Cardoso de Oliveira
2
, Gabriela Ribeiro ZUCCO
2
, Fernando SABBAG
1
, Herculano da
Silva MARTINHO
3
, Janete Dias ALMEIDA
2
, Marcelo Ribeiro de ARAÚJO
1
1 - Centro de Referência de Álcool, Tabaco e Outras Drogas, Secretaria de Estado da Saúde. São Paulo, SP, Brazil.
2 - Universidade Estadual Paulista “Júlio de Mesquita Filho”, Instituto de Ciência e Tecnologia, Departamento de Biociências e
Diagnóstico Bucal. São José dos Campos, SP, Brazil.
3 - Universidade Federal do ABC, Centro de Ciências Naturais e Humanas. Santo André, SP, Brazil.
How to cite: Marques SS, Oliveira TMC, Zucco GR, Sabbag F, Martinho HS, Almeida JD, et al. Unlocking the secrets of saliva: the
promising potential of salivary biomarkers for evaluating crack use. Braz Dent Sci. 2023;26(4):e3892. https://doi.org/10.4322/bds.2023.
e3892
ABSTRACT
The forthcoming letter will encompass the following highlights: Crack cocaine use involves smoking a highly
addictive form of cocaine, which is a signicant concern in Brazil, particularly in urban areas. This addiction is
linked to various health problems, including cardiovascular issues, sexually transmitted infections (STIs) like
AIDS and syphilis, tuberculosis, and a notable increase in mortality, largely due to violent causes. Furthermore,
crack cocaine users are particularly vulnerable to dental caries, gingival inammation, oral mucosa lesions, and
xerostomia
KEYWORDS
Crack Cocaine; Oral Health; Quality of Life; Body Fluids; Biomarkers.
RESUMO
A próxima carta incluirá os seguintes destaques: O uso de crack envolve fumar uma forma altamente viciante da
cocaína, o que é uma preocupação signicativa no Brasil, especialmente em áreas urbanas. Esta dependência está
ligada a vários problemas de saúde, incluindo problemas cardiovasculares, infecções sexualmente transmissíveis
(IST), como a AIDS e a sílis, a tuberculose e um aumento notável da mortalidade, devido, em grande parte, a
causas violentas. Além disso, os usuários de crack são particularmente vulneráveis a cáries dentárias, inamação
gengival, lesões na mucosa oral e xerostomia.
PALAVRAS-CHAVE
Cocaína Crack; Saúde Bucal; Qualidade de Vida; Líquidos Corporais; Biomarcadores
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Braz Dent Sci 2023 Oct/Dec; 26 (4): e3892
Marques SS et al.
Unlocking the secrets of saliva: the promising potential of salivary biomarkers for evaluating crack use
Marques SS et al.
Unlocking the secrets of saliva: the promising potential of
salivary biomarkers for evaluating crack use
Crack cocaine use involves smoking a highly
addictive form of cocaine, leading to intense but short-
lived euphoria and severe health consequences [1].
Crack consumption in Brazil is a major concern,
particularly in urban areas [2]. High addiction rates
associated with extreme social consequences, such
as poverty, violence and crime, pose significant
public health challenges [3]. Moreover, crack/
cocaine addiction is related to several health
problems, such as cardiovascular problems, sexually
transmitted infections (STIs), especially AIDS and
syphilis, tuberculosis and a signicant increase in
mortality, especially due to violent causes [1,2].
Its ability to affect cognitive functioning has been
documented [1]. While crack abuse is a global issue,
Brazil is considered the world’s second largest crack
consumer market [4]. As a result, the referred scale
and the specic socio-economic factors in Brazil
differentiate it from other countries and demands
targeted interventions [1-4].
In the oral cavity, there are many adverse
effects associated with the use of crack on
oral health-related quality of life [5], such as
temporomandibular disorders due to bruxism,
which can also cause tooth wear, jaw pain
and headaches, leading to further oral health
issues [6-8], increase in decayed, missing and
lled teeth, especially due to the acidic properties
of crack cocaine vapor which causes erosion
of the tooth enamel, resulting in cavities and
tooth decay overtime [9-11]. In addition to
rupture of the periodontium, the vasoconstrictive
properties of crack cocaine reduce blood ow
to the gums, weakening the tissue and making
it more susceptible to infection, leading to gum
recession, bad breath, and, if left untreated,
tooth loss [6,9,12]. It can cause injury to the
oral mucosa, “dry mouth”, oral burns, sores on
the lips and inside the mouth due to the high
temperatures and chromosomal breakage of
cells in the oral mucosa [6,9,13]. In addition to
difculty swallowing and speaking, opportunistic
fungal infections, periodontal disease in advanced
stages and hyposalivation can also occur [9-14].
Biological uids contain proteins and other
molecules that can be used as biomarkers to detect
the presence of psychoactive substances (“drug
testing”) [15,16], patterns of consumption [17] or
to function as indicators of physiological processes
or diseases, such as those related before or in
response to a therapeutic agent [15,16,18]. Saliva,
a transparent watery uid secreted by the salivary
glands directly into the oral cavity which contains
more than 2,000 proteins and peptides involved in
a variety of different oral biological functions, is
an excellent diagnostic uid [16]. These proteins
and peptides can be characterized and analyzed to
monitor or identify various diseases by proteomic
analysis in crack addicts [17].
Considering drug testing, saliva offers
several advantages over urine for crack cocaine
use, such as more comfort for the individual,
thus preserving the individual’s privacy and
dignity during the testing process [19]. The saliva
collection is easier, simpler, less intrusive than
urine collection and has a reduced adulteration
risk [20]. In addition, saliva tests can detect
recent drug use, typically within a few hours
to a couple of days. It provides more real-time
information regarding drug exposure compared
to urine tests, which have a longer detection
window [21]. Detecting recent drug use may be
crucial in various settings and situations where
timely intervention is necessary [19-21].
Crack cocaine users are especially vulnerable
to dental caries, gingival inflammation, oral
mucosa lesions and xerostomia [15-17]. Salivary
biomarkers, due to their non-invasive nature
and ability to detect drug metabolites, have
shown promising potential for evaluating both
crack cocaine use itself and some of its main
complications, such as cancers and periodontal
diseases [15,16]. They offer a convenient and
accessible method for monitoring drug exposure,
assessing treatment progress and conducting
research on drug use patterns. Saliva-based
tests can provide real-time or recent drug use
information and might help in early detection of
crack cocaine abuse, intervention, and support
for individuals struggling with addiction [17].
Further research and validation are needed to
establish the reliability and accuracy of these
biomarkers in specic contexts [15-17].
Acknowledgements
We are grateful to the São Paulo Research
Foundation (FAPESP).
Author’s Contributions
SSM: Substantial contributions to the
conception and nal approval of the version to
be published. TMCO: Conception of the letter,
substantial contributions to the conception and
nal approval of the version to be published.
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Braz Dent Sci 2023 Oct/Dec; 26 (4):/
Marques SS et al.
Unlocking the secrets of saliva: the promising potential of salivary biomarkers for evaluating crack use
Marques SS et al.
Unlocking the secrets of saliva: the promising potential of
salivary biomarkers for evaluating crack use
GRZ: Substantial contributions to the conception,
drafting of the article, translation and final
approval of the version to be published. FS:
Critical review, final approval of the version
to be published. HSM: Critical review, final
approval of the version to be published. JDA:
Conception of the letter, revising it critically for
important intelectual content and nal approval
of the version to be published. MRA: Substantial
contributions to the letter, revising it critically for
important intelectual content and nal approval
of the version to be published.
Conict of Interest
No conicts of interest declared concerning
the publication of this article.
Funding
The authors disclosed receipt nancial support
from São Paulo Research Foundation (FAPESP)
for the research and authorship through grants
#2020/10362-0 (Almeida JD), #2021/14395-3
(Oliveira TMC) and grant #2021/06500-1
(Zucco GR), and National Council for Scientic
and Technological Development (CNPq, grants
numbers 406761/2022-1,311933/2021-1).
Regulatory Statement
None.
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Braz Dent Sci 2023 Oct/Dec; 26 (4): e3892
Marques SS et al.
Unlocking the secrets of saliva: the promising potential of salivary biomarkers for evaluating crack use
Marques SS et al.
Unlocking the secrets of saliva: the promising potential of
salivary biomarkers for evaluating crack use
Janete Dias Almeida
(Corresponding address)
Universidade Estadual Paulista “Júlio de Mesquita Filho”, Instituto de Ciência
e Tecnologia, Departamento de Biociências e Diagnóstico Bucal, São José dos
Campos, SP, Brazil.
Universidade, Instituto, Faculdade, Departamento, Hospital, Grupo, Laboratório,
Cidade, UF, País.
Email: janete.almeida@unesp.br
Date submitted: 2023 May 18
Accept submission: 2023 Aug 18
